by Tiffani Washington

Whether it’s from a movie, celebrity hearsay or some other largely fictional account, most of us can recall a tale of someone experiencing a heart attack in the throes of passion. In reality, only about 1 percent of all heart attacks occur during sex, and far less than 1 percent of heart attack survivors die due to a sexual encounter. Still, it’s easy to see why a recovering heart attack survivor might be a bit timid rekindling romance without a doctor’s green light.

Supporting that notion, a new study finds that patients who were sexually active before suffering a heart attack were one and a half times more likely to recapture their sex lives if they received guidance on the topic before leaving the hospital.

While it’s no surprise that sexual activity tends to decline slightly for both men and women during the year following a heart attack, or acute myocardial infarction (AMI), researchers found that many patients who said they did not get medical counsel prior to hospital discharge either unnecessarily delayed or refrained from sex.

In a survey of 1,879 heart attack patients, less than a half of men and roughly a third of women recall receiving instructions about when to safely return to sexual activity before leaving the hospital. After a year of follow-up, only 41 percent of men and 24 percent of women reported having a discussion with their doctor about sex since their heart attack.

Results from the study published  in The American Journal of Cardiology are in line with early findings presented at an American Heart Association conference in 2010. Lead author, Stacy Tessler Lindau, MD, associate professor of obstetrics and gynecology at the University of Chicago Medicine, said the study underscores the need for more doctors to address sex as an important part of overall physical function, even after a life-threatening event such as a heart attack.

“Doctors need to understand the significant role they play in helping AMI patients avoid needless fear and worry about the risk of relapse or even death with return to sexual activity,” said Lindau, a renowned expert on helping women with complex illnesses maintain sexual function. “Receiving instructions, prior to hospital discharge, about resuming sex was a major predictor of whether patients resumed sexual activity in the year following AMI. For women, this was the only significant predictor. The discharging cardiologist has detailed knowledge of the patient’s condition, has provided life-saving care and is best positioned to advise on the safety of engaging in physical activity, including sex.”

Without counseling, patients are left to make their own, often flawed, assumptions about risk associated with sexual activity. Multiple studies have shown that sex puts less of a strain on the heart than people might think.

“This study may help doctors address issues that they’re traditionally reluctant to discuss,” said study author, Harlan Krumholz, MD, professor of medicine and epidemiology and public health at Yale University School of Medicine. “We’re showing that addressing sexual health may make a difference to long-term outcomes.”

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By Tiffani Washington

Chances are you don’t spend much time, if any, sharing the intimate details of your sex life with your doctor. Though the topic is difficult to avoid when walking past a newsstand or watching any given hour of primetime TV, sex remains a matter of great sensitivity in our personal lives. Approaching this taboo territory during a doctor visit can be difficult - for both the patient and the doctor.

The problem with a “don’t ask, don’t tell” policy is that when doctors avoid asking questions about the sexual activities of their patients, they may miss an important link to overall wellness.

Results of a new comprehensive national survey of U.S. obstetrician-gynecologists on their communication with patients about sex have found that too often doctors aren’t having “the talk” with their patients. And when the topic of sex does find its way into a doctor’s office or exam room, chances are the discussion only skims the surface.

The report, “What We Don’t Talk about When We Don’t Talk about Sex,” uncovers the shortfalls in doctor-patient communication around sexual matters and examines the barriers that may be limiting the range of dialogue in a typical evaluation of a woman’s general health. The study was published online last week in the Journal of Sexual Medicine.

The survey, conducted by a team of University of Chicago researchers, found that while nearly two-thirds of OB-GYNs routinely inquire about patients’ sexual activity, other aspects of female sexuality are not routinely addressed. Only 40 percent of those surveyed routinely ask questions to assess for sexual problems or dysfunction. Far fewer, 29 percent, routinely ask patients about satisfaction with their sexual lives and only 28 percent routinely confirm a patient’s sexual orientation.

Given the well-established link between sexual function and overall health, the study’s authors say their findings point to a clear need for stronger medical guidelines on conducting a thorough sexual history.

“As a practicing OB-GYN, many of my patients say I’m the first physician to talk with them about sexual issues,” said Stacy Tessler Lindau, MD, associate professor of obstetrics and gynecology at the University of Chicago Medicine, and the study’s lead author. “Sexuality is a key component of a woman’s physical and psychological health. Obviously, OB-GYNs are well positioned among all physicians to address female sexual concerns. Simply asking a patient if she’s sexually active does not tell us whether she has good sexual function or changes in her sexual function that could indicate underlying problems.”

There is strong evidence of a high prevalence of sexual function concerns among women. Recent studies estimate that roughly a third of young and middle-age women and about half of older women experience some sort of sexual problem such as low desire, pain during intercourse or lack of pleasure.

For most, the concerns go beyond physical — in fact, the impact of sexual dysfunction can be far reaching. In addition to strained relationships, many women experience worry, shame, guilt and feelings of isolation. If the doctor doesn’t ask, patients often assume the topic is not welcome for discussion.

“Many women are suffering in silence,” Lindau said. “Patients are often reluctant to bring up sexual difficulties because of fear the physician will be embarrassed or will dismiss their concerns. Doctors should be taking the lead. Sexual history taking is a fundamental part of gynecologic care. Understanding a patient’s sexual function rounds out the picture of her overall health and can reveal underlying issues that may otherwise be overlooked.”

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By Dianna Douglas

Maybe you’re the type of person to see a tiny nonsensical phrase in the credits of a movie and actually dig into it online. Be careful—you might find yourself sucked into a mystery story. Over the course of a week, you get a text message from someone you’ve been mindlessly Googling, you get an email with a riddle, and you find a chatroom with hundreds of people asking questions about clues they’ve found. You pick up more hints in this puzzle—on your phone, from YouTube, in your inbox, on a major website like Amazon. By the time you have solved the mystery, you know that the entire cloak-and-dagger game was orchestrated by the movie studio to create buzz. And it worked.

Instead of marketing the next summer blockbuster, Melissa Gilliam, MD, professor of obstetrics and gynecology and pediatrics at the University of Chicago Medicine, wants to deploy these tools to keep urban kids from getting pregnant or contracting infections. If this goal hardly distinguishes her from a million other people working with disadvantaged youth, her methodology certainly does: she is inviting them to play a secretive, science-fiction transmedia game on their computers to get them to rethink contraception, STIs and the cycle of poverty.

“Playing games can shape social attitudes and transform behaviors,” Gilliam said. “But I am not certain if anyone has tried to use a transmedia game in this context with urban youth.”

First, an explanation: A transmedia game is a story that unfolds across multiple digital technologies. It is usually designed by a video game, movie, or television show creator for that subset of the audience who wants to take the experience out of the screen and into everyday life.

This transmedia game is being orchestrated by Gilliam and her colleague Patrick Jagoda, PhD, Mellon Postdoctoral Fellow of New Media in the Department of English at the University of Chicago. It will launch on March 12th, and will be live for two weeks. They and their team of game developers will drop clues online and in the real world during that time, leading young players on a scavenger hunt for health and science knowledge and letting the players create content for each other.

The first hint in the game is already being planted at various places across Chicago. The developers are also drawing players into the game with Facebook and Google advertisements. The ads will direct these curious people to a website. Right now, the website is just a countdown clock to March 12. When the game starts, it will be a hub of clues.

(The plot and characters are under wraps until it’s over, so don’t look here for spoilers.)

“We don’t know who will play the game,” said Ainsley Sutherland, the research coordinator for the project. “But it was designed by 14 to 17 year olds, for their friends and peers.”

The research group plans to collect demographic information, to survey the people who play, and to monitor the online forum to see what they learn by playing. Gilliam is hopeful that the game will reach the target audience of poor, urban young people of color.

“I hope they realize that their course doesn’t have to be determined for them,” Gilliam said. By helping the young players think critically about health disparities and increase their health literacy in an augmented reality game, Gilliam hopes they’ll feel empowered to choose their sexual path in real life.

“Sexual and reproductive health is about your sense of relationships, and where you fit in the world. Young people who reach their full potential know what dangers they face and what hinders them. And they learn to reach beyond it.”

Will they play? Will they run away at the faintest whiff of being educated by an academic medical center? Will they think more critically about their social and cultural pressures to make poor reproductive choices?

And the million dollar question: Will their sexual behaviors change? read more

By Dianna Douglas

A pregnancy is considered at “term” after 37 weeks. But there are critical growth stages that come next–a baby’s lungs, brain, and liver develop in the last few weeks in the womb. Women in the United States are often induced before the baby has fully gestated, which leads to a host of negative consequences. Kenneth Nunes, MD, assistant professor of obstetrics and gynecology, led an effort to slow down the rate of elective “early-term” deliveries between 37 and 39 weeks at the University of Chicago. In these video interviews, he discusses his motivations, methodology, and results.

In the first, Nunes discusses the risk of delivering early versus the risk of prolonging a pregnancy.

Nunes discusses how a pregnancy is induced, when it is necessary, and the possible effects of inducing.

Nunes discusses how he and the Women’s Care Group reversed the number of elective “early-term” deliveries at the University of Chicago.

Since the Roe v. Wade decision of 1973, abortion has been a woman’s legal right (with ever-changing state-specific restrictions) in the United States. But one factor often trumps the legal status of abortion: access. Though abortion training is required for medical residents studying to become obstetrician-gynecologists, physicians are not required to perform the procedure or even to refer a patient to a ob-gyn who will. That voluntary basis can create pockets of the country where access to an abortion provider is a larger obstacle than any legislation.

As a window into these access issues, a team led by Debra Stulberg, assistant professor of family medicine, conducted a survey of more than 1,000 Ob-Gyn physicians on their experience regarding abortion requests and providing the procedure. Their answers, published in Obstetrics & Gynecology, reflected how commonly ob-gyns are approached for the procedure - 97% of respondents said they had encountered patients seeking abortions. However, only 1 in 7 (14.4%) of those surveyed said that they had provided abortions themselves.

The data collected from other question on the survey allowed Stulberg and her colleagues to paint a picture of who was more or less likely to provide an abortion. Some of the results were unsurprising: female ob-gyns were more like to perform the procedure than men, those with strong religious beliefs were less likely to provide abortions, and those who worked at Catholic hospitals were very unlikely to provide the option to their patients. Geographically, ob-gyns from the Northeastern, Western, and urban regions of the United States were more likely to have performed an abortion, while those from the South, Midwest, and rural areas were less likely. That could contribute to large areas of the country where there are limited options for women seeking abortion - regions that happen to be where abortion providers commonly experience harassment, the authors note.

Breaking down the responses by age also reveals an interesting U-shaped curve. The most likely age group to provide abortions was ob-gyns 35 years or younger. But the second most likely were those aged 56-65 years old - the generation that was in medical school around the time of the Roe v. Wade decision. As that age group heads toward retirement, the number of abortion providers could drop even lower, the authors speculate, should the younger generation not pick up the slack. For responses to this data from both sides of this always polarized issue, see U.S. News & World Report. More coverage can be found at the Los Angeles Times, NPR, and the State Column.

Our New Facebook Home

Thanks to the hard work of our colleague Matt Wood, the Medical Center has a new Facebook page! The page will be updated daily with articles and videos about Medical Center care and research, including the occasional article from this here blog. If you are so inclined, please visit the page and click the all-important Like button.

Elsewhere…

It sounds counter-intuitive: burning the smooth muscle of the lung to improve symptoms for people suffering from severe asthma. But bronchial thermoplasty is a promising new procedure, and has worked for patients like swimmer Stephanie Manikas, featured in this CBS Early Show piece from Thursday. Manikas’ physician, the Medical Center’s Kyle Hogarth, has previously explained the procedure as part of ScienceLife’s Dr. FAQ series.

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By Dianna Douglas

The Affordable Care Act is nearly one and a half years old, but the complexity of its reforms and their gradual roll-out have made it difficult to grade. Different disciplines are still parsing the legislation, attempting to figure out how it will change the future of their field. Experts in the field of Family Planning and Contraceptive Research has been puzzling over an enormous and perhaps unanswerable question: How will health care reform affect the reproductive lives of women and girls?

That was the primary question at the section’s spring conference, “Reproductive Justice and Health Care Reform: the Impact of Reform on the Reproductive Health of Underserved Women and Youth.” The phrase “reproductive justice” connotes the activism to give women and girls of all races and incomes the access to the same choices and education for controlling their reproduction. Panelists argued that some aspects of the bill, particularly the expansion of insurance coverage, would benefit this cause. But there were also warnings about the political resistance, exemplified by Representative John Boehner’s statement that he doesn’t think reproductive health care services are the business of the federal government: “How can you spend hundreds of millions of dollars on contraceptives? How does that stimulate the economy?” he asked in 2009.

Speakers at the conference, which was co-sponsored by UChicago’s Center for the Study of Race, Politics and Culture, posed many unanswered questions about how the Affordable Care Act will affect women and girls in America. Some expressed hope that it could close the gap between black and white and rich and poor in all areas of maternal health, unintended pregnancy, intimate partner violence, and infant mortality.

But Harold Pollack, PhD, professor at the School of Social Service Administration, gave both sides of the story. He argued that the Affordable Care Act is not only health care policy, but it is the defining document of America’s public policy on reproductive health care.

“Near-universal health insurance coverage will reduce disparities in health,” Pollack said. One of the goals of the Affordable Care Act, passed by Congress and enacted by President Obama in 2010, was to stop people from skimping on health care when they couldn’t afford it. If enacted properly, the health care plan would extend reproductive health care to millions of women.

Under the law, Pollack said, insurers can no longer require a referral to see an obstetrician or gynecologist, and must offer women direct access to these specialists. They are required to pay for some preventative services, like screenings for breast and cervical cancers and sexually transmitted infections. Insurers are required to pay for certain vaccines for women. They have to pay for preventive care for children and adolescents, including screenings for pregnancy. And, insurers may be required to pay for contraception and other family planning services.

All of these requirements were designed to improve women’s health across income levels, but basic access to physicians is the key. “When you visit a doctor because your knee hurts, the truth is that she probably won’t do very much for your knee. But you’ll get your blood pressure taken. She’ll ask you about your diet. And she’ll recommend you for other screenings and lifestyle adjustments,” he said. Oregon recently found that poor people with health insurance were healthier than poor people without it.

Pollack’s keynote address was not uniformly cheerful, however. “The bill is vulnerable, and reform is a risk,” he said. The politics around health care reform have become poisonous, he said, and some of the best public policies in the bill are the most under attack.

Pollack lamented that the great benefits of health care reform won’t be enacted for a few years, during which time public opinion on health care reform could sour more dramatically. “Backloading was the sin of this bill,” Pollack said. It takes time for reforms to embed in society, he said and the legal challenges to the bill may stop the process before it can begin.

To keep the Affordable Care Act on track and make the reforms sustainable, Pollack suggested that the people who support the bill should put a human face on it. “Americans are deeply ambivalent about sexuality and reproductive health,” he said. “But even people who disagree with abortion are uncomfortable with making a poor woman carry a baby to term after a rape or if the pregnancy will seriously damage her health.”  The more human and less theoretical the reforms can become, the more likely they are to survive the next few years of budget cutting.

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A Magic 8-Ball for Cardiac Arrest

Cardiac arrest is one of the most common ways that people die, and hospitals need to be constantly vigilant about the threat of heart stoppage in their patients. So physicians have long sought to develop a way of predicting who is most at risk for cardiac arrest when checked into the hospital, such that extra care and surveillance can be taken. At the 2011 international meeting of the American Thoracic Society, held this past week in Denver, two Medical Center fellows presented research refining these early warning systems to make them a more effective hospital tool.

In the first study, pulmonary and critical care fellow Gordon E. Carr connected cardiac arrest with another frequent sight on the hospital ward: pneumonia. Carr’s study found that patients admitted with pneumonia are at elevated risk of cardiac arrest over the next three days after admission, and that almost 40 percent of these cardiac arrests occurred while the patient was outside of the intensive care unit. “We found a compelling signal that some patients with pneumonia may develop cardiac arrest outside of the ICU, without apparent shock or respiratory failure,” Carr said in a press release. “If this is true, then we need to improve how we assess risk in pneumonia.”

Adding extra caution about cardiac arrest to the care of patients with pneumonia is a specific way to improve surveillance. But to apply to more patients, a broader scale is needed, one that can be easily assembled from the vital signs that are already routinely measured in the wards. One such scale, called the Modified Early Warning Score or MEWS was tested by pulmonary and critical care fellow Matthew Churpek as a predictor of cardiac arrest, who found it to be better at predicting a cardiac arrest in the next 48 hours than any individual vital sign. But MEWS was designed for general risk of death, not specifically for cardiac arrest, and Churpek suggested a more specialized risk score could be calculated for use by hospitals. The benefits of such a measure, he said in a press release, would be immense.

“Rapid response teams are a complex and resource-intensive intervention, so providing evidence-based criteria for their activation is crucial,” Churpek said. “Our patients will do better if we can detect who is at high risk early enough to intervene and prevent a cardiac arrest.”

Doctors Against Ronald McDonald

Childhood obesity is a growing problem in the United States, and doctors point the finger of blame directly at increased consumption of junk food and fast food. Chains such as McDonalds have made noise about making their food healthier, especially for children, by posting calorie counts on menus and offering snacks such as apples and carrots instead of fries. But according to an open letter signed by over 500 health care professionals and placed in newspapers around the country this week, they have not done enough.

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By John Easton

Even by academic standards, the language was restrained. “It is likely,” the authors note, near the end of the discussion section, “that more patients with this tumor will appear as girls who were exposed in utero come to maturity.”

That quaint, passive construction, in the April 22, 1971, issue of the New England Journal of Medicine, triggered an active response. The three-page paper, “Adenocarinoma of the Vagina,” focused on eight young women, ages 15 to 22, with an extraordinarily rare tumor.

“While the disease had been described in older women, none of us had heard of it in young people,” recalled study author Arthur Herbst, MD, the Joseph Bolivar DeLee distinguished service professor emeritus and former chairman of obstetrics and gynecology at the University of Chicago.

Thanks to luck, diligence and some clever detective work, Herbst and colleagues figured out why. Early in their pregnancies, the mothers of seven of the eight women had taken a drug - a synthetic hormone called diethylstilbestrol, DES for short - to prevent miscarriage. The problem was that in the previous 25 years, an estimated 4.8 million women in the United States - and as many as 10 million worldwide - had taken DES during pregnancy. These eight cases were the first warning of a rare, delayed, but devastating side effect.

“While the medical community was being cautious,” recalled Susan Helmrich, a DES daughter who is now 55, “mothers who took DES were hysterical. They were basket cases. The daughters,” she added, “also went a little crazy.”

DES, created in 1938, was the first synthetic estrogen. It was a cheap, potent, unpatented pill - for humans or livestock. The FDA approved it in 1941 for a wide range of “estrogen-deficient states.” In 1947 they added miscarriage prevention. One advertisement claimed that DES could prevent abortion, miscarriage and premature labor and was “recommended for routine prophylaxis in ALL pregnancies.” In 1953, William Dieckmann, MD, chairman of obstetrics at the University of Chicago at the time, showed that DES had “no beneficial effect whatsoever on the prevention of miscarriage.” Nevertheless, the drug remained in use for that purpose. But then, beginning in 1966, the first few odd cases began turning up - young women with an old-lady tumor.

“Dr. Robert Scully, gynecologic pathologist at the Mass General and I got together seven cases of clear-cell adenocarcinoma and described their clinical and pathological characteristics,” said Herbst. They began interviewing the mothers. One mentioned that she took a drug during pregnancy, something called DES, and wondered if that had anything to do with it.”

“I was also following a mother whose daughter unfortunately died of this disease because it had never been diagnosed properly,” Herbst said, “and she mentioned the same thing.”

So he, his section chief Howard Ulfelder, MD, and epidemiologist David Poskanzer, MD, decided to design a study. By that time they had an eighth case; they then selected 32 controls: four for each case, daughters born at about the same time to women at the same hospitals. They found that seven of the eight mothers of daughters with cancer took DES during the first trimester for either bleeding or prior miscarriage, and only one of the 32 controls did. The odds of that happening by chance were less than one in 100,000.

As soon as the paper was published “it was all over the news,” Herbst said. read more

The University of Chicago is the birthplace of nuclear energy. So like proud but concerned parents, UChicago has kept a close eye on the benefits and challenges of nuclear power over the years since the first self-sustained nuclear reaction under Stagg Field. Thus, the battle to manage the consequences of the damaged reactors at the Fukushima I Nuclear Power Plant in Japan has drawn the University’s interest, and the short-term and long-term effects of that ongoing situation were the subject of a unique panel held on campus yesterday, “Lessons from Fukushima.”

Though nuclear power was created by scientists, discussing its use requires input from political and economic spheres as well. So the panel, assembled by the University of Chicago Alumni Association, brought together nuclear technologists (Hussein Khalil, director of the nuclear energy division at Argonne National Laboratory, and Mark Peters, deputy director of Argonne), nuclear policy watchdogs (Kennette Benedict, executive director of the UChicago-based Bulletin of Atomic Scientists), and energy economics experts (Robert Topel, director of the University of Chicago Energy Initiative). With such different perspectives, it didn’t take long for the panelists to find points of debate, reflecting the tug-of-war over nuclear power that has gone on for several decades.

Nobody disputed the magnitude of the Fukushima incident, with workers at the plant still struggling to limit core meltdown in at least three of the reactors as well as re-cooling spent fuel rods at the site. As well, the panelists agreed that the incident was very relevant to nuclear power in the United States, where roughly one-fifth of electricity is provided by nuclear plants, many of which use the same model as the Fukushima reactors. But opinions differed on what those consequences would be.

Khalil pointed out that this was the first natural disaster to cause “grave damage” to a nuclear power plant in nearly 60 years of their use, and that a similar occurrence was very unlikely in the United States. But Benedict argued that “very unlikely” wasn’t good enough for “the most dangerous technology on Earth,” and that not every safety precaution possible had been taken at Fukushima. Topel agreed with the latter point - “why build generators on the ocean side in a country that coined the term ‘tsunami’?” he asked - and noted that the renewed attention to the long-term dangers of nuclear power would only make it more difficult to build new reactors.

In fact, no new nuclear reactor has come online in the United States in 32 years, Khalil said. So while Argonne continues to research new designs for nuclear plants and new strategies for containing nuclear waste, the economic (and possibly now public opinion) barriers are too large. The most likely rescue for nuclear power may come from an unlikely source: climate change.

“If other technologies turn out to be a bust, and if we really are serious about reducing our carbon footprint and carbon pricing becomes important, then there is a technology we have that can produce a lot of energy at relatively low cost compared to the alternatives,” Topel said. “Then, nuclear energy will prosper.”

By the end of the 90-minute discussion, the panelists came back to common ground on a hopeful note. If a thin silver lining could be found on a disaster that hasn’t yet been completely averted, it’s that the events at Fukushima have re-opened the international dialogue on nuclear power - its immense benefits and equally immense costs.

“One of the positive externalities of the Fukushima accident is that many more people are interested in nuclear energy, and I think that’s terrific,” Benedict said. “It’s unfortunate that it takes an accident to do it.”

Elsewhere…

The conversation about cancer is changing, from a single disease classified by the organ where it appears to multiple diseases grouped by genetic and biological similarities. As ScienceLife has written before, the Chicago Cancer Genome Project is our local contribution to this strategic shift against “the emperor of all maladies.” This week the Los Angeles Times examined that research effort and others like it, speaking with project leader Kevin White and many of the Medical Center’s cancer experts collaborating on this new vision of how to classify and battle cancer.

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When health disparities in urban populations are discussed at the University of Chicago Medical Center, it’s not an abstract, far-away concept. Only a few blocks west and south of the hospital campus are some of the poorest neighborhoods in Chicago, where nearly every health statistic one finds is shocking. Pick any measure - diabetes, heart disease, obesity, infant mortality, or violence - and the numbers in some South Side neighborhoods are closer to those found in developing countries than they are to more affluent North Side neighborhoods mere miles away. The problem is exacerbated by a decline in health services on the South Side of Chicago, from losing more than 2,000 hospital beds in the last decade to a sparse density of grocery stores and exercise facilities.

In response to this health crisis, the Medical Center launched the Urban Health Initiative to execute a multi-faceted campaign of patient care, education, and research. But an important first step in fixing the health disparities on the South Side of Chicago is measurement, obtaining updated and accurate statistics on the healthcare needs of the region and cataloging the resources already available. At the MacLean Center for Clinical Medical Ethics seminar series earlier last week, associate professor of obstetrics/gynecology and medicine Stacy Lindau updated the progress of the UHI’s measurement arm, the South Side Health and Vitality Studies.

The first aim of the SSHVS is to build a map - not of transportation routes, but of neighborhood assets. Recently, organizations such as the World Health Organization and the Robert Wood Johnson Foundation have started to define an area’s health system as “intersectoral,” stretching beyond direct medical care to other aspects of the community that impact the population’s health. For the last two years, the Community Asset Mapping project of the SSHVS has sent out college and high school volunteers to measure assets such as grocery stores, gyms, daycare centers, government services, churches, and more on the South Side of Chicago. The fruits of those efforts are twofold: both a resource for the community and a baseline for UHI research on improving the broader infrastructure of the region, Lindau said.

“Has anyone ever described anywhere all the components of an intersectoral health system and how they’re working together? Has it ever been empirically evaluated or studied? The answer is no,” Lindau said. “But where are we starting to this? Here on the South Side of Chicago, where we’re mapping every single built asset in the primary service area of the University of Chicago…and trying to understand: if everybody’s in the health system, then what’s everybody’s role?”

So far, 11 of the 34 community areas that make up Chicago’s South Side have been mapped, and the information is already proving its value as the “highest-quality asset list for this region,” Lindau said. Compared to the most recent commercially-available resource guide, the mapping project found 4o percent more assets…and found that 30 percent of the resources listed in the commercial guide were no longer in existence. Unlike that flawed information, the mapping project’s data is available for free through a customizable map program on southsidehealth.org (one of many website domains the program has wisely snapped up for community outreach purposes) that allows visitors to search by asset-type and location for 16 different categories. Lindau also hopes to someday incorporate the information into electronic medical records, so that patients can take home a printout of their nearby health resources after a doctor’s appointment.

“You can’t do this on Yelp or Google,” Lindau said. “You can’t map places by disease or by need. I think we have something really special here.”

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Stacey Sandbo and Stacy Lindau counsel a patient at the PRISM clinic. (Photo by David Christopher)

If your oncologist is worried about your sex life, you’re probably a man.

Stacy Lindau, associate professor of obstetrics/gynecology and geriatrics, has been researching how often women get help for sexual problems after surviving cancer, and the data are grim. Almost none of the women in her study got treatment, and half of them said they wanted it.

Breast or gynecologic cancer is rough on a woman’s sexuality. It often means hormone treatments, chemotherapy, or surgical disfigurations. Cancer could take a breast, the ovaries, or most of the reproductive tract.

Typical results: severe pain during sex, dryness, and difficulty with arousal and orgasm. A mastectomy or hysterectomy will often leave scars that make a woman feel less feminine and attractive. Add that to frequent bladder infections or incontinence after sex, and women find they’re facing some complex problems in bed after cancer. Sometimes the problems persist for years.

Despite abundant research about the negative effects of breast and gynecologic cancers on a woman’s sexuality, a 2002 survey found that physicians generally do not discuss it with their patients. This is in stark contrast to prostate cancer, Lindau said, where men and their doctors talk early and often about preserving sexual function. The dialogue usually begins as soon as a man is diagnosed with prostate cancer, and continues through treatment and beyond.

Lindau, who made national headlines in 2007 by telling Americans about the active sex lives of senior citizens, surveyed hundreds of survivors of breast and gynecological cancer for a study published in Cancer. She asked them who wanted a physician’s advice for sexual problems. Forty-eight percent of young cancer survivors said they did. Interest peaked in women between 48 and 55 - over 52 percent.

It dropped to a fifth among the women over 65. Still, that’s a lot of older women wishing a physician would explain to them why their sex life stalled after cancer and how to get their groove back.

So if women want this help from their physician, why aren’t they asking for it?

One reason is that patients overwhelmingly prefer for their doctor to initiate the discussion. That, however, is a can of worms that physicians won’t open without somewhere to refer their patients for treatment.

“There are few clinics in the United States with the expertise to treat sexual problems in women and girls with cancer,” Lindau said. The University of Chicago has the only one in Illinois, and one of few in the country - the PRISM clinic (Program in Integrative Sexual Medicine for Women and Girls with Cancer).

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Janet Rowley rides her bike in front of the Gwen & Jules Knapp Center for Biomedical Discovery. (Photo by Jason Smith)

It never gets old hearing the story of how Janet Rowley found the first genetic cause for cancer in the early 1970’s, so it’s a delight to read this week’s New York Times conversation between Rowley and reporter Claudia Dreifus. The interview retraces Rowley’s steps from working with mentally disabled children at Cook County Hospital through her almost accidental training in cytogenetics and her most famous discovery - the chromosomal translocation that causes acute myeloid leukemia. While Rowley has been repeatedly honored for her contribution to the concept of cancer as a genetic disease (and continues to remain a yearly subject of Nobel speculation), she remains understated in looking back at her life’s work.

“People accuse me of being too humble. But looking down a microscope at banded chromosomes is not rocket science. If I hadn’t found it, somebody else would.”

To go with the New York Times interview, the University of Chicago Facebook page put out a call for questions to Rowley, and have received some interesting thoughts. There’s still time to get your question in there for one of the most respected cancer researchers in the United States and a key figure in the history of genetic disease research. [See also Lisa Belkin's post on the New York Times parenting blog about recent research on barriers against women in science, in which she cites Rowley's example.]

Elsewhere…

As a kid growing up in the Chicago suburbs, I remember being trained in emergency procedures for the seemingly infinitesimal chance of a Midwest earthquake originating in the New Madrid fault in Southern Missouri and Illinois. But despite recent rumbles in the Chicago area, it’s been 200 years since the last New Madrid quake to get into the 7’s on the Richter Scale, according to this nice New Madrid By the Numbers post by natural science blog +/- Science. Perhaps those school drills weren’t so crazy after all - the blog points out that in 2003 the U.S. Geological Survey estimated a 7 to 10 percent chance of a major New Madrid earthquake in the next 50 years.

Blue penguins, and what they have to say about how feather color is produced.

Things are finally getting back to normal in Chicago after last week’s blizzard, but amazing stories of Chicagoans helping each other out during the storm continue to pop up. Here’s one story, from Medill Reports, of a woman who delivered her baby at the Medical Center in the midst of the blizzard Wednesday.

Hillary Rosner, one of the many cool people I met at Science Online 2011, has a new blog at PLoS with the excellent name of Tooth & Claw (from Tennyson’s “Nature, red in tooth and claw,” often associated with natural selection). In her first post, she brings up a fascinating fruit fly name from our own Manyuan Long - “jingwei,” named for a Chinese myth of a woman who drowns and is reincarnated as a bird to have her revenge on the sea. As the 1993 study describes, the gene was once thought to be a “pseudogene” without function, but was later revived and used by Long to study the origin of new genes - an area he still studies today.

Finally, what better way to prepare for Valentine’s Day than reading Brian Switek’s article on dinosaur sex at Smithsonian Magazine. I love the lede.

It is widely acknowledged that racial or ethnic discrimination can negatively affect a person’s health. But how can a scientist measure this impact? The treatment that a person encounters due to the color of their skin, their language, or their country of origin is likely a chronic stimulus, encountered over their entire life rather than during a discrete period of time. How that person perceives or reacts to discrimination may also vary widely from individual to individual - some may shrug it off or internalize the damage, some may grow angry and lash out. Wrapping one’s statistical arms around such a huge variable is nearly impossible.

One way around this problem is to locate a finite period of elevated discrimination against a particular group, and measure the impact of that event upon health. Diane Lauderdale, professor of epidemiology in the Department of Health Studies, found just such an event in the terror attacks of September 11, 2001, and the brief but intense harassment of Arab-Americans that followed. In her talk for the MacLean Center of Clinical Medical Ethics seminar series in January, Lauderdale detailed how she studied a link between post-9/11 discrimination and birth outcomes for a paper in the journal Demography (pdf).

While it might be hard to pin down the discrimination experienced by people of Arabic origin over the course of their lives in the United States, their life in the months after the attacks was undoubtedly more stressful. According to the American-Arab Anti-Discrimination Committee, more than 700 violent incidents were directed toward persons who were perceived to be Arab in the nine weeks after 9/11. But a massive media and government pushback likely limited the duration of this out-of-control hatred, with the director of the ADC commenting in December 2001 that “My impression is that we are rapidly returning to what one would unfortunately call a normal amount of hate crimes.”

Lauderdale chose to focus on pregnant women, who are particularly sensitive to stress. High levels of corticotropin-releasing hormone - a peptide increased by stress - can induce early labor, producing babies that are premature and/or underweight. Lauderdale hypothesized that pregnant Arab-American mothers might have given birth to more low birth weight babies in the six months following 9/11 than they had during the same months in the previous year.

One problem: while Lauderdale had access to the birth certificates of more than 1.5 million children born in California from 2000-2002, the certificates categorized race only by black, white, American Indian, Asian, and Other - no Arabic. Fortunately, previous work by Lauderdale and colleagues had developed an algorithm for predicting a person’s Arab origin using their first and last names. While the algorithm was admittedly imperfect, it was able to create enough of an enriched sample to conduct the comparison, Lauderdale said.

Her analysis found that the births of most groups (white mothers, black mothers, foreign born mothers) were unaffected by the events of 9/11, with virtually no difference in the risk of having a low birth weight baby between the two years. But for the 15,000 Californian women with Arabic names analyzed, there was a small but significant spike in low birth weight babies from October 2001 to March 2002. Children born to those mothers were 34 percent more likely to be underweight than babies born to Arabic mothers from October 2000 to March 2001.

To break the Arabic group down even further, Lauderdale looked at whether each child was given a traditionally Arabic name, potentially a sign of stronger ethnic identity. While the number of Arab names given to newborns did not change before and after 9/11, babies with “traditional” names were more than twice as likely to be born underweight in 01-02 compared to the same months in 00-01. Babies with more “American” names, on the other hand, were almost unperturbed, with only a 16% higher chance of being underweight at birth.

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This past week has been Nobel Prize week, and while none of the winners so far have had a University of Chicago connection (unlike last year’s trio), it’s still good fun for science spectators. Trying to divine a common theme from all of a year’s winners is probably futile - the selection process at the Royal Swedish Academy of Sciences is still pretty mysterious, and doesn’t seem to follow any consistent logic in the laureates it spits out. This year, the Thomson Reuters predictions - considered by many to be the best - have produced an ohfer so far, despite throwing out anywhere from 4-7 names for each of the prizes. The 2010 list is typically scattershot, with a mix of established science and science with yet unrealized potential; the only theme I can pick up is “non-American.”

Medicine: Occasionally, the Nobel committee is accused of waiting too long to award a prize. This year’s award in physiology or medicine, awarded to British scientist Robert G. Edwards for his work on in vitro fertilization, may fit that charge. The first baby produced by IVF procedures developed by Edwards and colleague Patrick Steptoe was born more than 30 years ago, on July 25, 1978. Since then, over 4 million “test tube babies” have been born to parents who would not otherwise have been able to have children. It’s kind of amazing, then, that the leaders of IVF had not previously been awarded the Nobel Prize - and sadly, Steptoe did not live to receive the honors, having died in 1988 (Nobel rules forbid posthumous awards). According to media reports, Edwards himself is in poor health and was unable to grant interviews about winning the award. Of course, the Vatican had its own criticisms of the winners.

Physics: Rather than rewarding a scientific discovery several decades after the fact, this award was given to science that, according to many experts, hasn’t yet ripened. Russian scientists Andre Geim and Konstantin Novoselov were recognized for the development of graphene, an extremely thin and extremely strong material thought to be useful in everything from solar panels to satellites. The emphasis is on “thought to be,” because the material was only discovered in 2004, and has yet to be incorporated into a commercially available product. Interestingly, the main gripe here was that it may have been more appropriate for the chemistry Nobel rather than the physics prize. Geim also notably becomes the first scientist to win both the Nobel Prize and its illegitimate brother, the Ig Nobel Prize, which he won for his research on levitating frogs.

Chemistry: If this were a fairytale, this prize would seem to be not too stale, not too fresh, but just right. Richard Heck, Ei-ichi Negishi, and Akira Suzuki each have an organic chemistry reaction that bears their name, and are considered to have laid important early groundwork for the burgeoning field of molecular engineering. The trio invented and refined the art of “palladium-catalyzed cross-coupling,” which finds a way to stick formerly contact-shy carbon atoms together. While the process is not exactly a household name, its impact is felt in medicine cabinets around the world. “Cross-coupling methods are now used in all facets of organic synthesis, but nowhere more so than in the pharmaceutical industry, where they are used on a daily basis by nearly every practicing medicinal chemist,” organic chemist Eric Jacobsen told ScienceNOW.

Elsewhere…

In the same issue of Archives of General Psychiatry where Daniel Le Grange’s study of family-based anorexia treatment was published, another Medical Center study probed the link between ADHD and teenage suicide. A study of 125 children diagnosed with attention deficit hyperactivity disorder between 4 and 6 years of age were three times as likely to attempt suicide between ages 9 and 18, compared to a control group of non-ADHD children. “The importance of this study is simply that it confirms that ADHD in children is not something to take lightly,” lead author Benjamin Lahey, professor of epidemiology, told WebMD.

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The early discovery of the high-risk breast cancer genes BRCA 1 and 2 has made the disease a testing ground for how genetic testing can be translated into actual health benefits. The relationship between gene mutations and disease risk is not always crystal clear, but BRCA1/2 is a notable exception: women with a mutation are as much as ten times more likely to develop breast cancer. That heavy knowledge has created many ethical debates about the value of testing a patient for the risk mutations, weighing the benefits of knowing and rigorously screening versus the stress of not knowing whether any preventive measures can truly offset the genetic cancer risk.

The latter half of that equation takes a hit today with an article in the Journal of the American Medical Association that clarifies the benefits of risk-reducing surgery in patients with BRCA1 or 2 mutations. A multi-institutional study, including researchers Wendy Rubinstein and Funmi Olopade of the University of Chicago Medical Center, looked at the outcomes of thousands of women who tested positive for BRCA1/2 mutations, about half of whom chose to undergo at least one type of risk-reducing surgery. Some patients opted for masectomy, some chose risk-reducing salpingo-oophorectomy (RRSO) - the removal of the ovaries and Fallopian tubes - while others chose no surgery at all.

When researchers compared the rates of breast and ovarian cancer among the three groups, they found dramatic evidence in favor of preventive surgery. In women who underwent risk-reducing masectomy, zero percent contracted breast cancer in the following three years. Not a single case in a high-risk population, where among BRCA1/2 mutation-positive women who did not undergo masectomy breast cancer was found in 7 percent of subjects over the same three-year period.

But a masectomy is a major procedure, and despite improvements in surgical technique and cosmetic reconstruction, it carries its own substantial risk and lifestyle changes. By comparison, removing the ovaries and Fallopian tubes in an RRSO surgery is a lower risk procedure that can even be performed in outpatient settings, according to an accompanying JAMA editorial. After a mutation-carrying woman is done having children, physicians strongly recommend salpingo-oophorectomy followed by hormone replacement therapy.

The benefits of that strategy were also shown in the new paper, as RRSO decreased the risk of both ovarian and breast cancer. Again, the magic number of zero pops up in regards to cases of ovarian cancer in BRCA-2 women who underwent RRSO, while barely 1 percent of women with the BRCA-1 mutation contracted ovarian cancer after the procedure (relative to 3 percent of women without RRSO). What’s more, RRSO decreased the risk of breast cancer by two-thirds (in BRCA-2 subjects) or one-third (in BRCA-1). Those effects manifested themselves in lower mortality, which RRSO reduced by more than half in those with no prior breast cancer and 70 percent in those who had a previous cancer diagnosis.

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